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What is a Healthcare IT Platform?

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What is a Healthcare IT Platform?

  1. 1. What is a healthcare IT platform? By Shahid N. Shah (based on Marc Andreeson’s definitions)
  2. 2. Who is Shahid?• 20+ years of software engineering and multi-site healthcare system deployment experience• 12+ years of healthcare IT and medical devices experience (blog at http://healthcareguy.com)• 15+ years of technology management experience (government, non- profit, commercial)• 10+ years as architect, engineer, and implementation manager on various EMR and EHR initiatives (commercial and non- profit) Author of Chapter 13, “You’re the CIO of your Own www.netspective.com Office” 2
  4. 4. First came healthcare servicescentralization… www.netspective.com Source: Jason Hwang, Innosight, via Jeff Selberg of IHI 4
  5. 5. …then comes decentralization anddisruptive innovation www.netspective.com Source: Jason Hwang, Innosight, via Jeff Selberg of IHI 5
  6. 6. Which leads to adaptive businessmodel innovation… Viability Models www.netspective.com Source: Ian Morrison, The Second Curve, via Jeff Selberg of IHI 6
  7. 7. …and means the full patient record isin various places that must connect www.netspective.com Source: Jeff Selberg, IHI 7
  8. 8. Conclusion: we need real platforms www.netspective.com 8
  10. 10. Definition according to Marc Andreesonfounder of Netscape & OpswareA "platform" is a system that can be programmedand therefore customized by outside developers --users -- and in that way, adapted to countless needsand niches that the platforms original developerscould not have possibly contemplated, much lesshad time to accommodate....The key term in the definition of platform is"programmed". If you can program it, then its aplatform. If you cant, then its not. www.netspective.com 10
  11. 11. Most health IT systems are apps, notplatform – be careful what you’re buying• Remember: if you can program it, then its a platform. If you cant, then its not.• In this case “you” is not the developers but people outside the original development team. This is crucial – if only the original developers can add to a system, it’s not a platform.To verify if something is a platform, ask the developers asimple question: “can I, without your help or being on yourserver, create software that connects to your system andallows me to extend it?”If the answer is no, it’s not a platform. Period. www.netspective.com 11
  12. 12. A real platform’s power curve Value as a platform High-value Platform Platform Number of ecosystem partners, community size, integration points www.netspective.com 12
  13. 13. The Ideal Healthcare Platform• Offers Type 1 connectivity through REST that can be consumed by third-parties.• Offers Type 2 connectivity through Java, .NET, PHP or other language plugins that can be developed by third parties.• Offers Type 3 execution capabilities by hosting 3rd party code in a cloud environment. www.netspective.com 13
  14. 14. Platform Type 1: Access APIMarc Andreeson writes that Type 1 is the kind of Internet platformthat is most common today. This is typically a platform provided in theform of a web services API -- which will typically be accessed using anaccess protocol such as REST or SOAP.Architecturally, the key thing to understand about this kind of platformis that the developers application code lives outside the platform --the code executes somewhere else, on a server elsewhere on theInternet that is provided by the developer.Examples: PracticeFusion, eBay, Paypal, Flickr, Delicious• The entire burden of building and running the application itself is left entirely to the developer• The easiest kind of Internet platform to create www.netspective.com 14
  15. 15. Platform Type 2: Plug-In APIThis is the kind of platform approach thathistorically has been used in end-userapplications to let developers build newfunctions that can be injected, or "plug in", tothe core system and its user interface.In the Internet realm, the first Level 2 platformwas the Facebook platform followed byLinkedIn, OpenSocial, and others. www.netspective.com 15
  16. 16. Platform Type 2: Facebook ExampleMarc Andreeson writes that when you develop a Facebook app, you are notdeveloping an app that simply draws on data or services from Facebook, asyou would with a Level 1 platform. Instead, you are building an app that actslike a "plug-in" into Facebook -- your app literally shows up within theFacebook user experience, often as a box in the middle of a page thatFacebook otherwise defines, such as a user profile page.• The third-party app itself lives outside the platform• The entire burden of building and running a Level 2 platform-based app is left entirely to the developer• Unlike a Level 1 platform where the burden of exposing the app to users is also placed on the developer, Level 2 Internet platforms -- as demonstrated by Facebook -- will be able to directly help their developers get users for their apps• Level 2 platforms are significantly harder to create than Level 1 platforms www.netspective.com 16
  17. 17. Platform Type 3: Runtime EnvironmentIn a Level 3 platform, the huge difference is that the third-partyapplication code actually runs inside the platform -- developer code isuploaded and runs online, inside the core system. For this reason, incasual conversation Marc Andreeson refers to Level 3 platforms as"online platforms".A Level 3 platform will also superset Level 2 and Level 1 -- i.e., a Level 3platform will typically also have some kind of plug-in API and somekind of access API.A Level 3 platforms developers upload their code into the platformitself, which is where that code runs. As a developer on a Level 3platform, you dont need your own servers, your own storage, yourown database, your own bandwidth, nothing... in fact, often, all youwill really need is a browser. The platform itself handles everythingrequired to run your application on your behalf. www.netspective.com 17
  18. 18. Platform Type 3: The Future• Level 3 platforms are much harder to build than Level 2 platforms.• The level of technical expertise required of someone to develop on your platform drops by at least 90%, and the level of money they need drops to $0• The Level 3 Internet platform approach is much more like the computer industrys typical platform (PC) model than Levels 2 or 1.Level 3 platform examples include: Ning , Salesforce.com,Amazon.com www.netspective.com 18
  19. 19. The Ideal Health IT Platform Provides Secure Social Patient Patient Communications, Meaningful Use EHR Relationship SMS, IM, E-mail, Voice, Modules Ready for Management (PRM) and Telehealth Certification E- Patient Education, Blue Button, HL7, X.12, commerce, Ads, Subscrip Calculators, Widgets, HIEs, EHR, and tions, and Activity-based Content Management HealthVault Integration Billing Accountable Care, Patient Consent, Patient Family and Patient Care Continuity Permissions, and Community Engagement and Coordination Disclosure Management www.netspective.com 19
  20. 20. Comparison with legacy applicationsDesigned for transaction Designed for patient / processing and documentation Legacy Modern provider engagement www.netspective.com 20
  21. 21. Comparison with legacy applications Legacy Modern Web vs. internal apps separation Same app on web and internal Fixed workflows, non-social Customizable social workflows Fixed screens and UI Themable / Branded UX Standalone applications Designed for integration & mashups Extensible fields & dynamic Static fields & relationships relationships www.netspective.com 21
  22. 22. Modern Platform ConnectivityIHE-compliant health information exchange components that currentlysupport:• Patient identity cross referencing (PIX v2/v3)• Patient demographics query (PDQ v2/v3)• Multi-patient query (MPQ)• Cross-community patient discovery (XCPD)• Cross-enterprise document sharing (XDS, XDS-I, XDS-MS, XDS-LAB, XDS- SD)• Cross-community Access (XCA)• Cross-enterprise user assertion (XUA)• Document subscriptions (DSUB)• Shared Value Sets (SVS)• Audit Trails and Node Authentication (ATNA)• Basic Privacy and Patient Consent (BPPC) www.netspective.com 22
  23. 23. THANK YOU